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Clinical Focus
11 APRIL 2025 ausdoc. com. au
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Source: AusDoc website; 3-27 March.
A patient’ s self-directed move to a meat-based diet for IBS symptoms has unintended effects on her recurrent axillary abscesses.
Dr Liz Fraser GP in Canberra, ACT.
JUNE, a 40-year-old public servant, presents as a new patient for a checkup. Her main concern is that she has been eating an almost carnivore diet for at least a year. While she feels well, she’ d like to know that her food choices are not harming her health.
June has a background of IBS, for which she had a colonoscopy many years ago. At that time, mild chronic inflammation was noted. She reports she first tried reducing sugar, then cutting out gluten and processed foods, and experimenting over time with her diet. June now eats mainly meat, eggs and cheese, with few vegetables and a little fruit. This has been effective for her gut symptoms. She occasionally eats out and notices that she invariably feels worse the next day.
June has also noticed that since eliminating trigger foods, she has had no recurrence of axillary abscesses. These multiple abscesses first developed in her mid-20s, during pregnancy.
June then had frequent flare-ups, with more severe abscesses requiring drainage and antibiotics, typically twice a year. Since changing her diet 12 months ago, June has not required any such intervention, nor experienced any new abscesses.
Previously, a hospital surgeon suggested a diagnosis of hidradenitis suppurativa( HS). However, she has not been given a formal diagnosis. June is pleased in any case that her condition— usually described as incurable— has been quiescent, apparently because of a change of diet. These benefits have motivated her to stick with her current eating pattern, which she finds sustainable.
As a teenager, June had acne and was treated with oral isotretinoin. Her mother has similar though less florid lesions in her axillae.
On examination, June looks well, with a BMI of 21kg / m 2 and blood pressure of 125 / 85mmHg. Both axillae have multiple subcutaneous nodules and old scars without evidence of active inflammation. The appearance is consistent with HS, Hurley stage II( see figure 1). 1 Examination is otherwise unremarkable.
The GP orders nutritional, metabolic and inflammatory pathology and reads up on HS.
Discussion
HS, also known as acne inversus, is a chronic auto-inflammatory skin condition that affects apocrine glands in intertriginous areas. It is
characterised by persistent or recurrent boillike nodules and abscesses that lead to purulent discharge, sinus formation and scarring. HS may be diagnosed in the presence of typical lesions in characteristic locations that persist or recur. 1 With recurring abscesses, pain, scarring and discharge in sensitive locations, the condition may have significant psychological impact. 2 The Hurley staging system is one of a number of scoring systems used to characterise severity, extent and treatment response with the condition( see box 1). 2
Estimates of prevalence range from 0.05 % to 4 % globally. 2, 3 HS is more prevalent in women, with severity fluctuating with menstrual cycles and exogenous hormones. 2, 4
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